Need advice whether to have surgery or not.
11/07/2017 at 4:32 pm #11093
I was hoping some of you could help me face my dilemma. I’m a 30 year old male who has a small inguinal hernia.
Honestly, the only time I really feel pain or discomfort is after being on my feet all day, going for a long hike, etc. Otherwise, generally speaking I don’t even realize it is there. When I am laying down, you cannot see it and my skin is is completely flat. If I am standing up looking down at it, you can see a bulge. It varries in size depending on how active I am that day, but It’s about the diameter of a quarter or half-dollar, and maybe pops out of the skin 1-2cm. It’s not tender or painful to touch.
I’ve been to my PCP and the nurse practitioner for the surgeon I have chosen. He is the chief of surgery in a medium-sized city hospital. They all advised me to get it fixed, but also if it’s not painful then waiting is fine until a better time.
I have scheduled a surgery date for Nov. 30th of this year, but I do see the surgeon in 9 days to discuss.
I am just extremely worried that I am rushing into this. I’ve read all of the horror stories about chronic pain, and I will regret my decision so much if that happens. Right now I know the level of discomfort I am in, but the unknown of what will be post-op really scares me.
I have modified my lifestyle a little bit — I think twice about lifting something heavy, or I would probably turn down a game of backyard soccer with my friends. But otherwise, I’ve continued to live normally. My job requires a mix of desk job and on my feet, with some lifting of 30-50lbs and I am doing that fine, with the exceptions of long 10-12 hour days like I mentioned above.
Do people with my size hernia, and minimal pain get surgery? Should they?
If you have any advice for me, I’d appreciate it.
11/08/2017 at 1:56 am #15198drkangParticipant
Waiting just does not make sense.
Your hernia will eventually get bigger and bigger.
Waiting is only delaying the decision time.
It is understandable that you are concerned about complications after a hernia repair.
Obviously it is important to have a surgery with few complications.
If so, it is better to search for a hospital or doctor who has a low-complication hernia operation, not just delaying the operation.
In general, tissue repair is safer than mesh repair.
So try to find a doctor who is good at tissue repair.
I think that’s what you need to do at this point.
11/08/2017 at 3:38 pm #15199WasInTNMember
I was diagnosed with IH sometime around 2008 with no bulge, no pain and nothing. Never knew even what IH was. PCP during a routine exam said I can wait since it was beginning to form. So I just ignored and continued my life. Till 2013 that is. I used to jog, do yoga and all. No pains no nothing. Then during 2013 I noticed a bulge forming and increasing in size by week. The pain was bad during bowel movement and sometimes during hoops shooting in the driveway. Other than that there was nothing. But during long drives when I sat for hours, the pain would kick me with sharp interruptions (thanks to the pain I never slept while driving. LOL). At that stage I tried the yoga and other exercises to see if the hernia could be reversed. Did not work. I also found my brother and father had similar IHs. My dad died without ever having a surgery and waited over 20 years and never had a bulge or anything. But my brother had bulge and had surgery after I had mine. Brother also had surgery on both sides. I had only right side.
Long story short, I got my hernia repaired in 2013 with Dr. Goodyear of PA with mesh. I flew there with family (wanted to go alone but family said nothing doing, we are coming with you) and spent 4 days. This was after research on Internet and talking to Dr. G on phone.
So my impression (note that I said impression, not medical advice) – Till the bulge forms you are OK to delay the surgery but need to be V-E-R-Y cautions. Once the bulge formed you are out of luck for waiting. You need to get it fixed or it will only grow further. If your lifestyle is like lifting heavy stuff then it will get worse quicker. But surgery is the way to go from now on. Which surgeon you choose what kind of surgery he does and what suits you depends on your heredity since IH runs in families and the tissue is weak by genetics. If you want advice from me I would first research your surgeon because surgeon skill is THE MOST IMPORTANT factor in mesh surgery. If you choose tissue surgery consider genetics since it can reoccur. I would wait a month before doing extensive research and then go for surgery. I waited over 2 months after the bulge showed up, and yes and bulge is also not noticeable when you lie flat and pain diminishes but that does not mean IH has gone away. The yoga exercises etc., at this stage when the bulge has formed will only make it worse – from my point of view.
Now the question – what happens if your situation goes bad before your research and you are rushed to ER? Well that can happen and you will need ER surgery. It is that simple. But hopefully it won’t happen that way. Well it did not happen to me but that does not mean it cannot happen to you. It can. It is like driving on highway. Will you be safe? Yes probably. Can you be killed in an accident. Yes it is possible. So what to do? Stop driving on highway? You know the answer. It is an obvious thing.
Choose wisely. And if you want to know how to choose wisely, rent the Indiana Jones movie in which the steel shirt wearing knight tells Indiana “your friend has chosen badly,” and “you have chosen wisely.” Just kidding. Do your research, select a good surgeon, go in peace. You will be alright. With my name handle you can search this forum for other “wisdom” I threw randomly for help if you think you need any. But research well. I say this because a bad surgeon can screw up an easy surgery and can cause life long problems. All good luck to you.
11/10/2017 at 1:49 am #15202quote kevin-pa:
The number of permutations of “hernia’ and “mesh’ is huge. There are many different types of mesh and surprisingly large amounts can be placed if the doctor chooses to do so. Trust but verify, I would say. Find a doctor who can say that they have talked to patients years after the surgery and can verify that they are satisfied. You’re only 30 years old. The stories you’ll find around the internet about surviving the first three months after surgery are pointless. It’s the long-term that matters. The surgery itself is not bad, nothing compared to how you’ll feel if you get the wrong combination of materials and surgeon.. You’ll be looking forward to surgery if you have problems with the mesh implant.
Read through the link below, and search “SAGES” and “hernia” on youtube. There is much change happening in the field, and it’s not all good. Good luck.
11/10/2017 at 2:07 am #15203
Here’s another thought – talk to a surgeon who removes mesh, even though there are few. You’ll probably get more in-depth advice one-on-one than on the internet. Most of them also use it for repair, from what I’ve been able to figure out, so should know what to use and how to use it. They will have seen what can go wrong and might offer some advice on how to avoid the problems. You might even decide to have them do the work if they’re available. Get several opinions, if you can.
11/10/2017 at 2:31 am #15205
Personally, if I had a small hernia that was not bothering me at all, and that a surgeon told me was low risk and thus suitable for watchful waiting, then I would likely wait. But if your hernia is painful or bothering you, or if a surgeon says it is risky, then of course consider surgery.
Aim to be comfortable with both your surgeon (or their expertise) and the procedure itself.
What symptoms do you currently experience? What procedure are you considering?
Where are you located? Perhaps someone can provide you with the name(s) of some regional hernia experts near you. It can be beneficial to get a second opinion.
Good luck, keep us updated on your decisions and progress.
11/10/2017 at 1:50 pm #15206minerParticipant
I was initially diagnosed about 2 years ago with a inguinal hernia. Ive been waiting but I dont have a bulge and the surgeon I saw was not 100% certain it was in fact a hernia and he would consider the surgery exploratory. He mentioned my risk level was the same as everyone else walking down the street. When the words exploratory were mentioned to me that meant wait until its gets worse. I have continued to research other surgeons as I do have sensations in that area that I wish I didnt.
If it ever restricts my activity though Id be quick to go in.
I would suggest putting together a long list of questions for the surgeon and make a decision after your next appt. If you dont like the answers delay and go to another surgeon
11/14/2017 at 9:41 pm #15208
Thank you for all the replies. This forum is a positive support system.
11/14/2017 at 9:48 pm #15209quote Chaunce1234:
I’m in Eastern Pennsylvania. 2 hours from NYC or Philadelphia. Considering regular open surgery. Only symptoms I have is a dull groin ache if I am on my feet all day long. Or if I go for a long hike, or something. Otherwise, I’d never even know I had it besides the small bulge. I have tried to look up photos online to see how my bulge compares to others. Somedays it’s barely there and almost flat. Other’s it might feel like it’s the size of an egg cut in half.
I am seeing the surgeon tomorrow, actually. As I mentioned, I had (have?) a scheduled surgery date for Nov. 30. But I called the office and explained I am putting that on hold for now. They understood and said “it’s your body, you have to make the right decision”. They advised me they will technically keep the date booked until after I talk to the surgeon (tomorrow). He is the chief of general surgery at a Geisigner satellite hospital.
One thing that intrigues me is that I only live about 90 minutes from the North Penn Hernia Institute and as somebody mentioned, Dr. Goodyear. When I first researched this months ago, I was turned off by that. A place that only did hernia surgeries almost sounded like a shady gimmick, and it was best done in a hospital setting. Although I am still researching, I now realize I was wrong, and perhaps a place that *only* does hernias is a better option. It’s one of my questions for the surgeon tomorrow, although I really don’t know how I’ll frame the question without insulting him.
11/15/2017 at 2:48 am #15210
If I were you, in your part of the country, I’d try to get up to see Dr. Brian Jacob in New York. I don’t know how the insurance systems work out there, so he might not be an option.
The more I learn, the more I realize that there are surgeons who are on the mesh program and there are those who realize that there are flaws with the mesh program and are trying to address them. You want somebody who realizes that mesh is not the fix-all that it’s described to be.
11/18/2017 at 6:01 pm #15223drtowfighKeymaster
Watchful waiting is a very safe option for most. That said, most young patients will eventually get their hernia repaired d but it may be decades before you get symptomatic enough to have it repaired. It’s really your choice.
11/18/2017 at 9:34 pm #15225
I visited brian Jacobs. My consult with him was very positive and I feel he is very thorough and skilled. My visit wasn’t for hernia repair but to see if pain i had from prior hernia repair with mesh was causing the issue. Although I’m sure he prefers to use mesh for repairs I also think he would be amendable if a patient wanted only a tissue repair. However, if I remember he does not take insurance but it is worth double checking. You also aren’t that far away from dr. Belyanski in Annapolis MD who I also highly rx.
11/27/2017 at 1:09 am #15230quote kevin-pa:
How did the appointment go?
It sounds like the hernia doesn’t bother you much which is great. Also a chief of surgery would presumably have a good number of hernia procedures under their belt with a lot of experience, but you can always ask the surgeon how many hernias they have fixed too if you might find that helpful.
If you want a second opinion for whatever reason, the following is a list of eastern USA surgeons that either have a particular interest/specialty in hernias and/or possibly offer non-mesh repair if appropriate to the patient. Obviously there are going to be many great docs that are not on this list too.
– Dr Brian Jacobs in New York, NY
– Dr Samer Sbayi in Long Island, NY (trained at Shouldice clinic in Toronto)
– Dr William Meyers in Philadelphia, PA (special focus on athletes, sports hernia, and core injuries)
– Dr Alexander Poor in Philadelphia, PA
– Dr Jarrod P Kaufman MD in Brick, NJ
– Dr. Andrew Boyarsky in New Brunswick, NJ
– Dr Igor Belyansky in Annapolis, MD
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, IN
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Jonathan Yunis in Sarasota, FL
– Dr Robert Tomas in Fort Meyers, FL
Good luck and keep us updated on your decisions and progress.
11/29/2017 at 10:20 pm #15237
Hi everyone, great suggestions.
Does anybody know if Dr. Brian Jacobs only does laparoscopic surgery? I always have heard open technique is better for chronic pain. (I think I read a study one time… rates of pain were higher with lap)
Also, howabout Dr. Goodyear at North Penn Hernia Institute?
11/30/2017 at 6:53 pm #15245
Hi I saw dr. Jacobs to see if he could diagnose if my mesh was casing me my pain. He is a bright guy and has a lot of excellent reviews. I do believe he specializes in laparoscopic repair but mentioned he could do open repair too. He does advocate mesh but feel he might be willing to do a pure tissue repair-not sure how many he has done. Though. Double check I don’t think he takes insurance and the operation is pricey. Check your out of netweoe insurance benefits
11/30/2017 at 10:54 pm #15246
Thank you Jnomesh. I hope Dr. Jacobs was able to help you.
I think he takes out-of-network insurance, but that can get pretty pricey also. Also, if I buy private insurance through blue cross/blue shield, all of the plans do not include out of network.
Dr. Jacobs also takes cash according to their website. I am lucky in the fact that I have some money saved up, and I would honestly pay whatever it takes to have this done correctly. But does anybody know roughly what we are talking about with a “cash” surgery? $15,000? $30,000? More?
12/01/2017 at 9:45 pm #15251
Don’t hold me to it but I think he mentioned that hernia repair is $12,500
12/03/2017 at 7:57 pm #15255quote Chaunce1234:
You can add me to that list that can offer above, I’m in Richmond, VA.
12/03/2017 at 8:26 pm #15257Momof4Participant
I agree that Dr. Procter should be added to the list! I haven’t had surgery with him, but had an office consult for a mesh problem. My problem ended up being better handled with Dr. Towfigh, but Dr. Procter offered very insightful advice and answered all of my questions. He even consulted with other physicians to help me find the best solution for my situation. Thanks, Dr. Procter, for offering your expert advice here. It is truly appreciated.
12/04/2017 at 4:59 am #15262quote kevin-pa:
Take this with a huge grain of salt because this could be outdated or otherwise inaccurate information, but based on what I’ve read elsewhere
– Shouldice Clinic in Toronto Canada is about $7,000 USD, including procedure, all meals and three days in their hospital
– A sports hernia repaired in Philadelphia is about $14,000
– A Desarda repair in Florida is about $5,000
– A sports hernia repaired in Munich Germany is about $7,000 (or 5000 euros)
– A standard laparoscopic repair at a standard US hospital is about $30,000
The best way thing to do is call a clinic and ask for the total quote, for the entire procedure and standard followup, for cash payment of the particular surgery you are seeking.
Generally speaking, an open repair will be cheaper than a laparoscopic repair. Add in the robotic lap repairs, or any complex surgeries, re-dos, etc, and price surely goes higher as well. You will see some very high quotes and billing details out there if you look for them.
Bottom line; it’s expensive.
12/04/2017 at 8:36 pm #15263
Thank you again everyone. I really appreciate all of the responses. What is strange is in the last few weeks the hernia has begun to bother me. Originally it was only after long days. Now I have a heaviness/pressure sensation depending on the way I stand or sit. I have a window of time from Jan-April where I am not working much as my current job is largely seasonal. It would be a good time to get the repair done.
Now comes decision time. Choosing a doctor, mesh or no mesh, lap or open, having it now vs. waiting, measuring current pain level vs. potential life changing forever chronic pain that could be much worse. I wish it was easier to decide.
It’s great that the internet has allowed us to communicate quickly, research info, and have forums like this. But it also opens up the flood gates of “what-if’s” and overwhelms your mind in terms of the amount of information. I would bet the internet has drastically increased the number of hypochondriacs on this planet.
12/09/2017 at 11:14 pm #15273quote Momof4:
You’re very welcome.
12/09/2017 at 11:16 pm #15274quote kevin-pa:
We can recommend expert, competent surgeons that can offer you the best outcome irrespective of the operation chosen.
You will be fine.
I would get it fixed.
I would consider traveling to a surgeon that is recommended if there isn’t one in your area.
12/10/2017 at 1:08 am #15284quote LeviProcter:
You seem to be overlooking completely the views of us that weren’t fine. I had my surgery in 2013 from a skilled well-known surgeon, using state of the art materials and methods. Nobody can guarantee that somebody getting hernia repair will be fine. There is still much luck involved, and many surgeons can’t really say if their past patients are fine or not. Nobody is keeping track. I wish it wasn’t true, but I’m a pretty smart guy, and I still got caught. Still figuring out how it happened.
Good luck kevin-pa. Do the ground work, and don’t let your guard down at the comforting words.
12/10/2017 at 1:46 am #15286
This is the second presentation I’ve watched by this guy, Dr. Todd Heniford. His other one was about how the problems with certain popular techniques impact everybody, including his own staff. His presentations are very focused on accurately evaluating, with real numbers, how well things work, short-term and long-term.
It’s pretty gruesome, visually, and not directly related to inguinal hernias. But if I was starting from today, I would find a doctor that talks like he does and can back up his or her views with numbers. This presentation touches on many of the issues that have been discussed in various threads across this forum. His approach is long-term care, even suggesting that doctors tell their patients before-hand that they might have to come back later, that there might be problems.
It’s worth watching just for the views on the industry and how people try to simplify complicated subjects. The talk really starts at about 4 minutes.
12/10/2017 at 1:25 pm #15287quote Good intentions:
I appreciate your thoughts and position. I’m sorry you did not have an optimal outcome. Thankfully, many in your situation, can achieve a cure.
Recognize that there are also serious complications (can supercede chronic groin pain, such as bowel perforation, bowel resection, etc) that can occur with a symptomatic hernia that isntrepaired.
Everything has risk.
Albeit this type of data on chronic pain, poor outcomes, is not recorded the overall outcomes in the literature support benefit at greater than risk.
Even in the most expert hands these issues can happen. We don’t fully understand chronic groin pain etc to be able to prevent in all patients.
Nothing can be guaranteed. You are correct.
One has to know risks on both sides of this equation and make a judgement that they can live with.
My comment above is a generalization, I recognize that, but the large majority do well.
12/11/2017 at 6:06 pm #15289quote kevin-pa:
I’m going to repeat my recommendation to find a surgeon who can say truthfully that they know their patients are doing well, long-term, and that those patients do the same types of activities that you plan to do. That was my one major mistake in choosing my surgeon. I trusted him for different reasons, but afterward, when I asked those questions, to see if he he’d seen my type of problem before, I found that many of his patients just moved on to other surgeons. I found that he just couldn’t accept that I was having problems, and eventually tried to push me off to other doctors. He even suggested medicating the problems away.
It was just his nature as a person. He was more business and procedure oriented than patient oriented. I was in and out and back home within a couple of hours for the repair, which was impressive. Coming back with problems wasn’t expected. It wasn’t in the business plan. As it turned out, he did have resources to seek advice from, which he eventually said he would do, but he had delayed and avoided for two years. And when he found that I had found another possible solution, he never came back with the information that he said he would.
So, there are very well-trained professionals out there who will do a great job of performing the procedure. But will be completely lost if you have problems. Since you’re active, playing soccer and things like that, I would put extra effort in to finding a doctor who knows that their method works for athletes. I tried to do that before my repair, I was just like you are, an active person who was worried and skeptical, but I couldn’t find anyone. And you can’t just call them up and ask, you have to make an appointment and wait and pay, and eventually your insurance company will stop paying.
The internet, unfortunately, is the best resource for information right now. You just have to sift through a lot of material to find something to grab on to.
12/12/2017 at 12:15 am #15293
I totally agree. And for me it is even more important than ever with the introduction of mesh. Because if you don’t get someone who is going to explain everything realistically it’s really in my mind borderlines on malpractice when you take into consideration what a nightmare mesh can cause if things go wrong.
my implanting surgeon was touted as an expert who has done many repairs. I not only had an emergency hematoma post surgery but he had the audacity to tell me that don’t worry the hematoma would help secure the mesh. When I went back to him 3 times post repair with pain over a year all I got was “no recurrence” give it time. Give it time so we would be outside of statute of limitations for mal practice?
Anyways indeed the mesh had folded up into a hard ball and I lived with it and pain for 5 years until a true specialist could see the mesh was folded on a cat scan. I had it removed. The explantknf surgeon said it looked like the either the mesh used was to big for the space or not enough space was made available by the surgeon for that size mesh. My wife recently ran into two people who had mesh surgery with the same surgeon and are having major issues.
so do your research carefully and I’d say if you are going down the mesh path find a surgeon who is an expert at taking it out to do your removal-that is the true definition of a specialist in my opinion.
my favorite is I read all the time on these threads that mesh is superior to the pure tissue repair and they quote their data. Yet the shouldice hospital reports recurrence and chronic pain at less then 1% way way less then mesh use. So what gives?
so what the surgeons are basically saying is outside of the specialty centers such as the shouldice hospital mesh is superior to the pure tissue repair. Delve a little deeper and the translation is this: hardly anybody does the pure tissue repair for hernias, students aren’t rained in it, and the devotion is towards mesh repairs.
so what has been created is a viscous cycle.
the fact that patients aren’t offered or have access to an alternative to hernia repair by qualified surgeons who specialize in this repair in this country is outrageous. Sticking something in people that is meant to be permanent and not come out-so if something goes wrong the patient is screwed all because the system claims that these plastc inflammatory devices are better.
And there is also something very wrong when these do fail and cause pain no one except a few handful of surgeons can figure out or admit that it is the mesh. So the patient is left to suffer in every way possible while the surgeons and doctors say everything is A-ok-off to pain management.
then after numerous hours of self advocacy and research we do find a surgeon to remove the mesh we have to travel and spend thousands out of pocket to try and roll the dice and fix this.
sorry for the rant.
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